What’s the maximum effective basal insulin dose in T2D?

  • Umpierrez GE & al.
  • Diabetes Obes Metab
  • 5 Feb 2019

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Glargine (Lantus) doses >0.5 IU/kg/day in patients with type 2 diabetes (T2D) do not improve glycemic control but may promote weight gain.
  • Instead, consider treatment intensification with prandial insulin or other type of glucose-lowering agent.

Why this matters

  • Basal insulins do not improve postprandial glucose levels, which typically worsen as T2D progresses. 

Study design

  • Pooled data from 3 prospective, randomized, controlled trials of ≥24 weeks in 458 patients with T2D uncontrolled on metformin, sulfonylurea, and insulin glargine U100.
  • Funding: Sanofi US, Inc.

Key results

  • From baseline fasting plasma glucose (FPG) 200 mg/dL, greatest reduction (~40 mg/dL per 0.1 IU/kg/day increase in insulin dose) in FPG with insulin doses ≤0.3 IU/kg/day.
  • Smaller FPG reductions at higher insulin doses, plateauing at ~15 mg/dL per 0.1 IU/kg dose increase at doses >0.5 IU/kg/day.
  • From mean baseline HbA1c 8.7%, greatest effect was 0.5 IU/kg/day, plateauing at ~0.3% for each 0.1 IU/kg/day increase.
  • Hypoglycemia incidence similar across insulin doses.
  • Mean weight increase of 1.4 kg seen with final insulin dose >0.5 IU/kg/day.

Limitations

  • Post hoc analysis, pooled data.
  • Requirement for both metformin and sulfonylurea use.
  • Small cohort samples.

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